scholarly journals Evidence of an active Cushing reflex in a preterm neonate with hyaline membrane disease: a case report

2021 ◽  
Vol 15 (1) ◽  
Author(s):  
Alan D. Rothberg ◽  
Johan Smith ◽  
Welma Lubbe
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Case Report ◽  
Intraventricular Hemorrhage ◽  
Preterm Neonate ◽  
Hyaline Membrane Disease ◽  
Progressive Increase ◽  
X Ray ◽  
Hyaline Membrane ◽  
The Brain

Abstract Background The Cushing reflex does not appear to have been described in preterm neonates. This case report shows the presence of an active Cushing reflex in a 32-week preterm neonate with hyaline membrane disease. Case presentation The 1.94 kg Caucasian infant was delivered by caesarean section following concerns about possible maternal infection and fetal compromise. Chest X-ray showed mild-to-moderate hyaline membrane disease and treatment was initiated with supplemental oxygen and nasal continuous positive airway pressure. It is probable that a pneumothorax occurred at 5–6 hours of age, with progression during the day. Interstitial air, pneumomediastinum, and tension pneumothorax were diagnosed on subsequent X-ray, and ultrasound of the brain showed a grade IV intraventricular hemorrhage. A review of the nurses’ recordings of heart rate, blood pressure, and respiratory rate showed a progressive increase in blood pressure accompanied by slowing of the heart rate and irregular respiration. These are features of the Cushing reflex that is elicited in response to raised intracranial pressure. Conclusion While well-described in older children and adults, in neonates the Cushing reflex has mainly been described in animal experiments and infants who have developed hydrocephalus. It is likely that in this case, the reflex was elicited as a result of a progressive increase in intracranial pressure due to the combination of elevated intrathoracic pressure, obstructed venous return from the brain, and concurrent intraventricular hemorrhage.

scholarly journals Case report: 2 cases of cardiac arrest caused by rhino-cardiac reflex while disinfecting nasal cavity before endonasal transsphenoidal endoscopic pituitary surgery

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Wen Wang ◽  
Hongwei Cai ◽  
Huiping Ding ◽  
Xiaoping Xu
Keyword(s):  
Risk Factors ◽  
Blood Pressure ◽  
Heart Rate ◽  
Cardiac Arrest ◽  
Case Report ◽  
Nasal Cavity ◽  
Pituitary Surgery ◽  
Case Presentation ◽  
Clinical Anesthesia ◽  
Vagus Reflex

Abstract Background Trigeminal-cardiac reflex (TCR) is a brainstem vagus reflex that occurs when any center or peripheral branch of the trigeminal nerve was stimulated or operated on. The typical clinical manifestation is sudden bradycardia with or without blood pressure decline. The rhino-cardiac reflex which is one type of TCR is rare in clinical practice. As the rhino-cardiac reflex caused by disinfection of the nasal cavity is very rare, we report these two cases to remind other anesthesiologists to be vigilant to this situation. Case presentation This case report describes two cases of cardiac arrest caused by rhino-cardiac reflex while disinfecting nasal cavity before endoscopic transsphenoidal removal of pituitary adenomas. Their heart rate all dropped suddenly at the very moment of nasal stimulation and recovered quickly after stimulation was stopped and the administration of drugs or cardiac support. Conclusion Although the occurrence of rhino-cardiac reflex is rare, we should pay attention to it in clinical anesthesia. It is necessary to know the risk factors for preventing it. Once it occurs, we should take active and effective rescue measures to avoid serious complications.

SKULL METASTASES OF FOLLICULAR CARCINOMA THYROID: A RARE CASE REPORT

2021 ◽  
pp. 24-25
Author(s):  
Smriti Kumari ◽  
Manoj Kumar Paswan ◽  
Nishat Ahamad
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Case Report ◽  
Body Temperature ◽  
Thyroid Gland ◽  
Basal Metabolic Rate ◽  
Rare Case ◽  
Follicular Carcinoma ◽  
Rare Case Report ◽  
Follicular Carcinoma Thyroid

The thyroid gland, usually located below and anterior to the larynx, consists of two bulky lateral lobes connected by a relatively thin isthmus. The thyroid is divided by thin brous septae into lobules composed of about 20 to 40 evenly dispersed follicles, lined by a cuboidal to low columnar [1] epithelium, and lled with PAS-positive thyroglobulin. The thyroid secretes hormones that control the heart rate, blood pressure, body temperature and basal metabolic rate

scholarly journals Midazolam for treatment of refractory neonatal seizures: a case report

1994 ◽  
Vol 52 (2) ◽  
pp. 260-262 ◽  
Author(s):  
José Luiz Dias Gherpelli ◽  
Francisco José C. Luccas ◽  
Israel Roitman ◽  
Eduardo Juan Troster
Keyword(s):  
Case Report ◽  
Status Epilepticus ◽  
Continuous Infusion ◽  
Seizure Control ◽  
Neonatal Period ◽  
Hyaline Membrane Disease ◽  
Water Soluble ◽  
Neonatal Seizures ◽  
Hyaline Membrane ◽  
Ischemic Encephalopathy

Midazolam is a short-acting water soluble benzodiazepine that has been used with an increasing frequency in the last years. Although there are reports on its use in status epilepticus, there is none in the neonatal period. A pre-term (35 w) AGA newborn infant with a severe hypoxic-ischemic encephalopathy secondary to grade ED hyaline membrane disease developed status epilepticus in the first 6 hours of life and was successfully treated with midazolam after phenobarbital and phenytoin failed to achieve seizure control. Dosage schedule was 0.2 mg/kg IV, followed by continuous infusion of 0.025 mg/kg/h. Midazolam is an effective drug for neonatal status epilepticus and more experience should accumulate before it can be routinely employed in the neonatal period. This case shows that it is a possible option before using more dangerous drugs, such as thionembutal.

scholarly journals INTRAOPERATIVELY DIAGNOSED CATECHOLAMINE SECRETING MASS: A CASE REPORT.

2020 ◽  
pp. 61-62
Author(s):  
Puneet Verma
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Case Report ◽  
Pulmonary Oedema ◽  
Asymptomatic Patient ◽  
Transient Increase ◽  
High Increase ◽  
Unique Challenge ◽  
Catecholamine Levels

I hereby present a case of an asymptomatic patient whose catecholamine secreting tumor was diagnosed intraoperatively due to acute high increase in blood pressure on tumor manipulation, thought to be arising from pancreas. The fall in blood pressure was also present on removal on mass. The transient increase in catecholamines also led to pulmonary oedema which was managed accordingly. The fluctuations of blood pressure and heart rate in line with blood catecholamine levels along with other complications like arrhythmias and pulmonary oedema in such cases provide unique challenge to anesthesiologists.

Alterations in Blood Pressure and Heart Rate Variabililty in Transgenic Rats with Low Brain Angiotensinogen

Hypertension ◽  
2000 ◽  
Vol 36 (suppl_1) ◽  
pp. 727-727
Author(s):  
Ovidiu Baltatu ◽  
Ben J Janssen ◽  
Ralph Plehm ◽  
Detlev Ganten ◽  
Michael Bader
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Baroreflex Sensitivity ◽  
Circadian Variation ◽  
Ang Ii ◽  
Transgenic Rats ◽  
Short Term ◽  
Baroreflex Control ◽  
Sd Rats ◽  
The Brain

P191 The brain renin-angiotensin system (RAS) system may play a functional role in the long-term and short-term control of blood pressure (BPV) and heart rate variability (HRV). To study this we recorded in transgenic rats TGR(ASrAOGEN) with low brain angiotensinogen levels the 24-h variation of BP and HR during basal and hypertensive conditions, induced by a low-dose s.c. infusion of angiotensin II (Ang II, 100 ng/kg/min) for 7 days. Cardiovascular parameters were monitored by telemetry. Short-term BPV and HRV were evaluated by spectral analysis and as a measure of baroreflex sensitivity the transfer gain between the pressure and heart rate variations was calculated. During the Ang II infusion, in SD but not TGR(ASrAOGEN) rats, the 24-h rhythm of BP was inverted (5.8 ± 2 vs. -0.4 ± 1.8 mm Hg/group of day-night differences of BP, p< 0.05, respectively). In contrast, in both the SD and TGR(ASrAOGEN) rats, the 24-h HR rhythms remained unaltered and paralleled those of locomotor activity. The increase of systolic BP was significantly reduced in TGR(ASrAOGEN) in comparison to SD rats as previously described, while the HR was not altered in TGR(ASrAOGEN) nor in SD rats. The spectral index of baroreflex sensitivity (FFT gain between 0.3-0.6 Hz) was significantly higher in TGR(ASrAOGEN) than SD rats during control (0.71 ± 0.1 vs. 0.35 ± 0.06, p<0.05), but not during Ang II infusion (0.6 ± 0.07 vs. 0.4 ± 0.1, p>0.05). These results demonstrate that the brain RAS plays an important role in mediating the effects of Ang II on the circadian variation of BP. Furthermore these data are consistent with the view that the brain RAS modulates baroreflex control of HR in rats, with AII having an inhibitory role.

Pulmonary Hyaline Membranes and Vascular Anomalies of the Lung: The "Lausanne Baby"

PEDIATRICS ◽  
1967 ◽  
Vol 39 (5) ◽  
pp. 791-792
Author(s):  
FORREST H. ADAMS ◽  
ADEL EL-SALAWY
Keyword(s):  
Blood Flow ◽  
Case Report ◽  
Pulmonary Blood Flow ◽  
Hyaline Membrane Disease ◽  
Vascular Anomalies ◽  
Hyaline Membranes ◽  
Hyaline Membrane

A very interesting brief case report, entitled "Pulmonary Hyaline Membranes and Vascular Anomalies of the Lung," was published in Pediatrics by Bozic. This case is commonly referred to as the "Lausanne baby" and is used by many to support the hypothesis that hyaline membrane disease is primarily related to reduced pulmonary blood flow. Although there are good reasons from observations in both man and animal to implicate reduced pulmonary blood flow as an important factor in the pathophysiology of hyaline membrane disease, we do not believe the "Lausanne baby" can be used to support this hypothesis.

scholarly journals The burden of hyaline membrane disease, mortality and its determinant factors among preterm neonates admitted at Debre Tabor General Hospital, North Central Ethiopia: A retrospective follow up study

PLoS ONE ◽  
2021 ◽  
Vol 16 (3) ◽  
pp. e0249365
Author(s):  
Binyam Minuye Birihane ◽  
Wubet Alebachew Bayih ◽  
Abebaw Yeshambel Alemu ◽  
Demeke Mesfin Belay ◽  
Asmamaw Demis
Keyword(s):  
Gestational Age ◽  
Neonatal Intensive Care ◽  
Preterm Neonate ◽  
Hyaline Membrane Disease ◽  
Preterm Neonates ◽  
P Value ◽  
North Central ◽  
Disease Mortality ◽  
Hyaline Membrane

Background Hyaline membrane disease (HMD) is a leading cause of morbidity and mortality in preterm newborn babies. Though, there are studies related to Hyaline membrane disease inclusive of all neonates, studies related to the burden among preterm neonates were limited. In addition, increasing neonatal mortality in Ethiopia could be related to increase in the burden of hyaline membrane disease among preterm neonates. Therefore, this study was aimed to assess the burden of hyaline membrane disease, mortality and its associated factors among preterm neonate admitted at neonatal intensive care unit, North Central Ethiopia. Methodology An institution-based retrospective follow-up study was conducted among 535 preterm neonates admitted at neonatal intensive care unit from January 1, 2014-December 30, 2017. Data were entered into EPi-data 4.2.0.0 and transferred to STATA version 14 statistical software for statistical analysis. Binary logistic regression was used for the analysis. All variables with P-value < 0.25 during bi-variable analysis were considered for multivariable logistic regression. Level of statistical significance was declared at P value ≤0.05. Results In the current study, proportion of hyaline membrane disease was 40% (95% CI; 35.8, 44.3) of which 49.5% died. Preterm neonate born with Gestational age of less than 34 weeks of age (Adjusted odd ratio (AOR = 2.64; 95 CI: 1.49, 4.66)), 5th minute Apgar score less than 7 (AOR = 2.2; 95% CI: 1.20, 4.07), and newborn with birth weight of less than 1500 gram (AOR = 2.4, 95% CI: 1.3, 4.3) were predictors of hyaline membrane disease. Conclusions The mean gestational age (±) was 33.46 (±2.55) weeks. The incidence of hyaline membrane disease among preterm admissions was high. Preterm neonate born with gestational age of less than 34 weeks of age, asphyxiated newborns and newborn with birth weight of less than 1500 gram were predictors of hyaline membrane disease. So, emphasis should be given on early screening, follow up and timely interventions for preterm neonate.

Thromboxane A2 acts on the brain to mediate hemodynamic, adrenocorticotropin, and cortisol responses

1998 ◽  
Vol 274 (5) ◽  
pp. R1353-R1360 ◽  
Author(s):  
Timothy A. Cudd
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
De Novo ◽  
Blood Pressure Response ◽  
Protective Function ◽  
Prostaglandin Synthase ◽  
Artificial Cerebrospinal Fluid ◽  
Cortisol Responses ◽  
Blood Pressure Responses ◽  
The Brain

Conditions that increase the formation of thromboxane A2(TxA2) also result in activation of hemodynamic and adrenocortical responses. The purpose of this study was to test the hypothesis that TxA2 acts directly on the brain to mediate these responses. Adult sheep were chronically instrumented with vascular and intracerebroventricular catheters. The TxA2 analog U-46619 (0, 100, or 1,000 ng ⋅ kg−1 ⋅ min−1) and artificial cerebrospinal fluid (CSF) were infused intracerebroventricularly for 30 min. Heart rate increased in response to 100 ng ⋅ kg−1 ⋅ min−1U-46619 infusions. Heart rate did not change over preinfusion values in response to the highest infusion rate, but values were elevated compared with the postinfusion period. Mean arterial pressure, ACTH, cortisol, hematocrit, and arterial pH (pHa) increased, and arterial partial CO2 pressure ([Formula: see text]) fell in response to 1,000 ng ⋅ kg−1 ⋅ min−1infusions of U-46619. Plasma vasopressin concentrations and arterial partial O2 pressure did not change. In a second study, U-46619 or artificial CSF was infused intracerebroventricularly during prostaglandin synthase blockade. Blockade reduced but did not prevent blood pressure responses to U-46619 infusion, suggesting that the U-46619 infusions increased prostaglandin synthase metabolism to contribute de novo TxA2 or a second metabolite to augment the blood pressure response. Heart rate, pHa,[Formula: see text], ACTH, and cortisol responses to U-46619 were not different with blockade. We conclude that TxA2 acts on the brain to mediate blood pressure, heart rate, pHa,[Formula: see text], hematocrit, ACTH, and cortisol responses. These findings support the hypothesis that TxA2 acts directly on the brain to promote cardiovascular and hormonal responses that may serve a protective function during conditions when TxA2 formation is increased.

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